Purpose::
Our aim was to evaluate the frequency, demographics, and clinicaloutcomes of ruptured large-incision (nucleus expression) extracapsularcataract extraction (ECCE) wounds due to trauma. These outcomesmay be useful in counseling patients as well as in risk-stratificationbased on presentation after injury.

Methods::
In a retrospective case series study, all ruptured globe injuriespresenting to the Massachusetts Eye and Ear Infirmary from January2000 to July 2006 were reviewed. Characteristics evaluated includeage, gender, final best-corrected visual acuity, mechanism ofinjury, ocular events during the initial repair and recoveryperiod, and final clinical outcome of the globe.

Results::
42 of 641 total ruptured globes between 1/1/2000 and 7/1/2006were ruptured ECCE wounds (6.6%). Of all open-globes over theage of 65, over a third were ECCE wound ruptures (39/109; 36%).The mean age of traumatic ECCE wound dehiscence was considerablyhigher than that of all ruptured globe injuries (83.42 vs. 43.18;p<0.002)). Twice as many women experienced ECCE wound dehiscenceas men (28 vs.14). 27 of 42 ECCE wound ruptures occurred secondaryto fall (64%). 86% were due to all forms of blunt injury (includingfall) and only 2 ECCE ruptures occurred during a motor vehicleaccident. Best corrected visual acuity (BCVA) outcomes wereas follows: 9 of 38 ECCE wound ruptures (24%) had a BCVA outcomeof 20/400 or better, and 76% had count fingers vision or worse(no follow-up data available on 4 patients). Conversely, ofthe 587 non-ECCE ruptured globes for which final BCVA is available,61% had a final visual outcome of 20/400 or better and 39% hadfinger-counting vision or worse. Of note, 64% of ECCE rupturedglobes had associated retinal pathology.

Conclusions::
Ruptured ECCE wounds comprise a significant percentage of rupturedglobes in the elderly population. These injuries occur mostcommonly in elderly women and frequently result from a fall.Compared to visual outcomes of all other open-globes, visualoutcomes in ECCE ruptured globes are poor, with only a quarterof cases seeing better than 20/400. Despite the limbal locationof ECCE wounds, a majority of cases had associated retinal pathology,likely explaining the poor visual outcome in this subset ofpatients.